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Vol. V, No. 12~ EINet News Briefs ~ June 28, 2002

****A free service of the APEC Emerging Infections Network*****

The EINet listserv was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EID's) among academicians, scientists, and policy makers in the Asia–Pacific region. We strongly encourage you to share their perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the listserv, use the reply function.

In this edition:
  1. Infectious disease information
  2. Updates
  3. Notices
  4. Journal Articles
  5. How to join the EINet email list

Below is a semi–monthly summary of Asia–Pacific emerging infectious diseases.

US (New York) – E. Coli
As of 21 June 2002, health officials have identified a total of 26 cases of E. coli in two towns in Rockland County, NY that are 10 miles apart. Two cases occurred in Orangetown, also known as Orangeburg, and 24 cases in Monsey. Although the outbreaks occurred at approximately the same time, they are thought to be unrelated. Tests have shown that the Orangetown girls and the Monsey children are infected with different strains of E. coli O157:H7.

On 14 June 2002 health officials in Orangetown confirmed E. coli O157:H7 contamination of ground beef found in the family freezer of a six–year–old girl who is seriously ill with E. coli O157 infection. The family purchased the contaminated meat on 12 May 2002 at a wholesale food store in West Nyack. On 7 Jun 2002, the state Department of Agriculture and Markets tested four meat samples chosen at random from the distributor, but all samples tested negative for E. coli O157 bacteria. For this reason investigators believe that the meat may have been contaminated after it left the store. The second Orangetown case is thought to have contracted E. coli O157 infection from the first case. The sources of the two outbreaks remain unknown.
[Promed 06/19/02, 06/21/02]

US (New Mexico) – Chronic Wasting Disease
The New Mexico State Department of Game and Fish declared an animal health emergency after a mule deer in White Sands Missile Range, New Mexico tested positive for chronic wasting disease (CWD), a deadly disease that causes brain damage in deer and elk. Imports of deer and elk have been temporarily halted and hunters are being encouraged to provide the heads of deer and elk within a 48–hour period of death for testing. As of yet, CWD has been found in free–ranging deer and elk in Colorado, Wyoming, Nebraska, Wisconsin, South Dakota of the United States and Saskatchewan, Canada. This is the first positive test of CWD in New Mexico.

Currently, there is no known relationship between CWD and other humans or animals diseases, such as the other transmissible spongiform encephalopathies (TSE) variant Creutzfeldt–Jakob disease (vCJD) and Bovine Spongiform Encephalopathy (BSE). However, state officials are encouraging hunters to follow precautions when handling dead game and advising hunters not to consume any neural tissue.
[Promed 06/19/02]


Philippines (Iloilo Province) – Dengue Fever
As of mid–June 2002, twenty–eight cases of dengue hemorrhagic fever have occurred in the province of Iloilo. For this reason health officials and Governor Niel D. Tupas, Sr. have raised a dengue alert in the province. In addition, the government is requesting that residents renew the practice of cleaning their surroundings and draining water containers to prevent the spread of mosquitoes. This is also known as the “4 o’clock habit” or “operation kaya–kulub (upside down)”. During the period from 2 Jan to 9 June 2002 the disease spread to 12 towns. According to Tupas, there have been no deaths and, on average, two people have fallen ill monthly.
[Promed 06/25/02]

Vietnam – Dengue Fever
According to the Vietnamese Ministry of Health (MoH), in the first four months of 2002 2,528 people have been reported to be infected with dengue fever in the southern provinces. This estimate includes five individuals who have died from the disease. Ho Chi Minh City and the provinces of Dong Nai, Tien Giang, An Giang and Binh Phuoc experienced the most number of cases. The MoH has advised all 19 provinces in the south to adopt appropriate preventive and treatment measures.
[Promed 06/25/02

Thailand (Bangkok and Khon Kaen) – Hand, Foot and Mouth Disease
On 20 Jun 2002 the Rainbow Land Child Development Centre, a child–care center in Bangkok, Thailand, was closed after 14 children developed hand, foot and mouth disease (HFMD). The outbreak began on 18 Jun 2002 when four to five children developed symptoms of HFMD, such as fever, sore throat, runny nose, mouth sores and painless rashes with blisters on hands, feet and buttocks. A doctor at Bangkok Nursing Home diagnosed the children with HFMD, a disease caused by several different enteroviruses. The most common cause of HFMD is coxsackievirus A16. Occasionally HFMD results from infection with enterovirus 71 or other strains of enteroviruses such as polioviruses and echoviruses.

According to the U.S. Centers for Disease Control and Prevention (CDC), HFMD begins with a mild fever, poor appetite, malaise, and often a sore throat. One to two days after fever begins sores that start as small red spots and then blister develop in the mouth. A skin rash, usually located on the palms of the hands and soles of the feet, develops over one to two days with flat or raised red spots. Symptoms usually disappear without medical treatment after approximately seven to 10 days. The incubation period for the disease is three to seven days. The disease is usually found in children aged five years and younger, with 20 to 30 cases reported each year in Thailand. Infection, which can be fatal, is spread through contact with nasal discharges, saliva, feces, fluid from blisters, and items used by an infected individual.

The child–care center has been inspected by the Health Department and deemed clean and hygienic. It is thought that the children may have contracted the virus from urine and waste. Officials have concluded that the virus causing this outbreak of HFMD is different from that which occurred in Singapore, when 200 schools were closed. The source of the outbreak has yet to be identified.
[Promed 06/21/02]

Hong Kong – Hand, Foot & Mouth Disease
More than 30 children from a kindergarten in Hong Kong have contracted hand, foot and mouth disease (HFMD). This viral disease is unrelated to the disease by a similar name, foot and mouth disease, which occurs in cattle, sheep and swine. The Health Department was first alerted to the outbreak on 13 Jun 2002. All children were treated and none required hospitalization. The outbreak is thought to be restricted to children belonging to a single class and, for this reason, the school in Tsuen Kwan O has remained open. However, health authorities have advised the school to request that parents keep their children at home until they are healthy.
[Reuters Health 06/19/02; Associated Press 06/18/02; Promed 06/19/02]


Republic of Congo – Ebola Hemorrhagic Fever
According to the World Health Organization (WHO), the Gabonese Ministry of Health (MoH) received reports of two deaths of suspected acute hemorrhagic fever syndrome in Ogooué–Ivindo Province on 19 June. Members from MoH and WHO traveled to Ekata on 20 June 2002 in order to investigate and identified two suspected cases of acute hemorrhagic fever syndrome as well as 31 contacts of the cases. Both cases became ill in Oloba, Mbomo district, near the Gabonese town of Ivindo, and both died in Ekata, Gabon. Health officials are continuing investigations. A previous epidemic of Ebola occurred between December and April 2002 in which 42 people died.
[World Health Organization 06/23/02]

Ecuador (Quito) – Foot and Mouth Disease Quarantine
Due to an outbreak of foot and mouth disease (FMD), the Ecuadorian Agricultural Health Service (SESA) quarantined cattle–raising areas northwest of Quito in Pichincha Province, effective on 17 Jun 2002. SESA identified at least 34 cases of FMD in the area. According to reports, the quarantine also will be enforced in the town of El Carmen, Manabi Province, where three cases of FMD have been detected. According to the director of the National Commission for the Eradication of Foot–and–Mouth Disease (CONEFA), the police and members of agricultural health organizations will take steps to control the spread of the disease in addition to implementing a vaccination program. Under the quarantine, movement of cattle through affected areas has been banned and only ranchers who possess a vaccination certification granted by CONEFA are permitted to transport cattle in nonaffected areas. Over the past several years, efforts have been made to prevent another outbreak through a national campaign to control and eradicate the disease.
[Promed 06/17/02]


US (Florida) – Hepatitis A Outbreak
Health officials in Central Florida, United States have confirmed a second death in Polk County from hepatitis A. A 36–year–old Auburndale man died from the disease on 5 June 2002. The cause of death was attributed to hepatitis A with complications from chronic hepatitis C infection. In the first five months of 2002, the Polk County Health Department has confirmed 185 cases of hepatitis A. However, more recently, officials have been documenting approximately four to seven new cases a week.

Officials are investigating the source of the virus, focusing on methamphetamine users and their contacts because injection drug users are identified as a high–risk group. Health officials are not certain how the Auburndale man contracted the disease, although tainted restaurant food has been ruled out. In April of 2002, six cases were linked to one restaurant, a Bartow landmark called John's Restaurant and Lounge. They contracted the disease in Jan 2002 after eating food handled by an infected cook and one died in March of 2002. At present the restaurant is declared safe. Investigations are continuing. [Editor comment: It is recommended that all persons with chronic hepatitis C infection get the hepatitis A vaccination (not immune globulin) to try and prevent this very serious complication of co–infection.]
[Promed 06/21/02]

Republic of Korea – Foot and Mouth Disease
An outbreak of foot and mouth disease (FMD) was reported 10 Jun 2002 in a pig holding approximately 58 km away from the first infected holding in Anseong. Another outbreak was also reported on 10 Jun 2001 in a cattle herd 2.8 km away from the first infected holding in Anseong. The causal agent of the outbreaks is foot and mouth disease virus serotype O. Laboratory diagnosis was made at the National Veterinary Research and Quarantine Service in Anyang, Kyonggi. Diagnostic methods used included clinical inspection as well as serological and virological testing. The source and origin of infection as well as the mode of spread are currently under investigation. As part of control measures taken during 8 Jun and 10 Jun 2002, health officials implemented movement control, maintained cleaning and disinfection of infected farms, and destroyed all the pigs and cattle in the affected farms. In addition, 5,265 pigs, 16 goats, 95 Korean native cattle and 124 dairy cattle from eight livestock farms within a 500–m radius of the infected farms were slaughtered as part of preventative efforts.
[OIE 06/21/02]


Asia–Pacific Facing Wider HIV/AIDS Epidemic
According to a new study the UN Economic and Social Commission for Asia and the Pacific (ESCAP), HIV/AIDS is rapidly reaching epidemic levels in parts of Asia and the Pacific. Until recently, only Cambodia, Myanmar and Thailand had documented significant nationwide epidemics. According to an UNWire report, there are seven million people living with HIV/AIDS in the region, where 60 percent of the world’s population resides. According to ESCAP, the number of people living with HIV/AIDS in the region may reach monumental proportions if the current rate of new infections persists. Countries in South Asia and East Asia are suffering the most dramatic increases in rates.
[UNWire http://www.unfoundation.org/unwire/util/display_stories.asp?objid=26183, 6/05/02]

Foot and Mouth Disease Vaccination Policy
The Temporary Committee on Foot and Mouth Disease (TCFMD) has been considering a vaccination policy as part of a contingency plan for foot and mouth disease (FMD) outbreaks. Committee experts believe there is no danger to human health from consuming products of vaccinated animals. However, members reportedly believe that more work on vaccines is necessary and that the effectiveness of such a policy is debatable. A key problem with vaccination is that there is no commercially available means of discriminating vaccinated animals from infected ones and several days are needed for effective immunity. Further consideration of vaccination methods, animal and human safety, and implementation procedure is needed.

A preventive vaccination has previously been used in Europe. The program aided in reduction of the numbers of outbreaks from hundreds of thousands in the 1960s to a couple of thousand in the 1980s and 1990s. However, the policy was abandoned in 1991 for trade reasons.
[Promed 06/19/02]


Early Detection of Variant Creutzfeldt–Jakob Disease
Researchers led by Dr. Robert G. Will, of the National CJD Surveillance Unit in Edinburgh, Scotland have described the early psychiatric and neurological characteristics of those with variant Creutzfeldt–Jakob disease (vCJD) using medical records of the first 100 people diagnosed with the disease in the United Kingdom. Currently, the only method for definitively diagnosing vCJD, a disease which is hard to detect early in disease progression, is through a brain autopsy. vCJD is believed to be transmitted through beef and other bovine products from cows infected with bovine spongiform encephalopathy (BSE).

The study, which appears in the 22 June 2002 issue of the British Medical Journal, found that the majority of those in early stages of disease had psychiatric symptoms, but that psychiatric symptoms follow neurological symptoms in 15 percent of cases. In the early stage of disease, patients commonly suffered withdrawal, anxiety, depression and insomnia and were often seen by a psychiatrist. There were no common neurological symptoms early on; however, in the early stage of disease progression some patients experienced persistent pain in their limbs, trunk or face. The authors also found that both types of symptoms are present in combination for 22 percent of cases from the onset of disease. The combinations of characteristics described in the study may help diagnose vCJD and recognition of symptoms in early disease progression may aid in detecting outbreaks of vCJD sooner.
[SOURCE: British Medical Journal 2002;324:1479� Reuters Health 06/21/02]

Variation in Response to Typhoid Fever Infection
Some bacterial pathogens, including Salmonellae, have the ability to establish latent or chronic infections. Researchers in the United Kingdom and Sweden have identified a single point mutation in mouse models that affects alternation between acute and chronic infection with Salmonella enterica, the bacteria that can cause Typhoid fever. Typhoid fever, a potentially life–threatening bacterial infection, is usually acquired through consumption of contaminated food or water. Symptoms of illness include fever, abdominal pain, fatigue, loss of appetite and red skin spots.

As part of their research the authors characterized a Salmonella typhimurium mutant that was known to establish persistent infection in certain mice. They did not expect to find that a single base pair change could produce such a substantial effect on the bacteria's pathogenesis. The mutation in the Salmonella genome that infects typhoid carriers disables a “house–keeping” enzyme that usually degrades genetic material to prevent a build–up in the bacterial cell. The results of this paper aid in understanding the distinction between acute and persistent infection through new findings related to the bacteria.
[Proceedings of the National Academy of Sciences 2002;99:8784� Reuters Health 06/18/02]

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